Statement of Account MITCHELL A KLINE, MD PC 700 PARK AVENUE NEW YORK, NY 10021 JEFFREY EPSTEIN 9 EAST 71ST STREET NEW YORK, NY 10021 Date Procedure Description Date Account No. Page # 07/27/2016 0000008048 1 Last Payment Date Amount 04/07/2016 1525.00 Paid by Paid By Charges Insurance Patient Adj. Balance 07/27/2016 99205 New Pt High Complexity 500.00 500.00 07/27/2016 11100 Biopsy/Skin, 1st 250.00 250.00 07/27/2016 11101 Biopsy/Skin Each Additional 125.00 125.00 0 - 30 Days Current 31 - 60 Days Past Due 61 - 90 Days Past Due 91 - 120 Days Past Due > 120 Days Past Due $875.00 $0.00 $0.00 $0.00 $0.00 Notes: CUT ON DOTTED LINE AND SEND WITH PAYMENT FOR BILLING INQUIRIES CONTACT Patient Balance Due 11875.00 -iefrAs7-4 EPS IN, JEFFREY t(I q, ACCOUNT NO. 0000008048 Statement Date: 07/27/2016 Please remit payment of $875.00 payable to: MITCHELL A KLINE, MD PC /6 EFTA00316268

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